Provider Demographics
NPI:1700429073
Name:BRUSIC, RICHARD ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:BRUSIC
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 RIVER ST STE 800
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2273
Mailing Address - Country:US
Mailing Address - Phone:518-271-1234
Mailing Address - Fax:
Practice Address - Street 1:433 RIVER ST STE 800
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2273
Practice Address - Country:US
Practice Address - Phone:518-271-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty